In addition to the debate within the field of psychology on Sex Addiction vs. Out of Control Sexual Behavior (OCSB), gender, culture, morality, and law have a significant impact on how compulsive sexual behavior is defined, viewed/judged, approached, and worked with. Perhaps one of the most difficult aspects to reconcile is the role (and history) of how morality and values–not all of which are shared and agreed to within our culture–shape the law and add to the stigma, fear, and shame experienced by those suffering from compulsive sexual behavior.
Ley (2012) credits Dr. Patrick Carnes with framing compulsive sexual behavior as an addiction; however, he points out that the “history and origins of the concept reveal clearly the moral and social values that are embedded throughout the theory of sexual addiction” (p. 8). Although he acknowledges “the long history of laws related to sexual behaviors” (Ley, 2012, p. 129), he argues there “is an even longer history of laws and social restrictions on sexual behaviors that do not represent crimes, as we think of them today, but are behaviors that society judges to be immoral or unacceptable” (Ley, 2012, p. 129). In addition to legal attitudes, Klein (2003) argues that what is considered deviant sexual behavior varies by social context (Klein, 2003, p. 77).
Similarly, in their review of the literature, Garcia and Thiabut (2010) found sexual addiction difficult to define and categorize due to the moral, religious, political, and social judgments surrounding it. What they discovered was a wide variety of views of sexual addiction as a form of paraphilia, obsessive-compulsive disorder, impulse control disorder, and “out of control” excessive sexual behavior. This lack of agreement in the field of psychology is evident based on how this behavior has been identified and treated with each edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM). For example, the DSM-III categorized this behavior as “Psychosexual Disorder Not Elsewhere Classified,” which is described as “distress about a pattern of repeated sexual conquests with a succession of individuals who exist only as things to be used (Don Juanism and nymphomania).” With regard to the DSM-5, many argued for a definition of sexual addiction that reflected the same behaviors, symptoms, and criteria as in the DSM-IV definition of substance addiction, this did not happen. Other names such as “hypersexual disorder” were proposed. Ultimately, it was found that more research was needed in order to define, diagnose, and treat sex addiction, including a more clear understanding of sexual norms. In summary, Ley (2012) concludes that a “significant challenge to the concept of sex addiction is that it represents a culturally bound concept reflecting changing social views of sexuality rather than medicine or scientific research” (p.108).
Concluding Thoughts on Compulsive Sexual Behavior/Sex Addiction in Sex Therapy
I believe it is important for an individual suffering from compulsive sexual behavior and those supporting them, to hold the social views of sexuality with open-mindedness and non-judgement. There may be aspects of an individual's sexual behavior that they feel needs attention and want to change, but there is a beautiful richness in the spectrum of sexual expression that social views and morals needlessly limit and restrict. Perhaps the conversation needs to shift to better understanding principles of sexual health, promoting sexual education, and empowering individuals to cultivate and express their sexuality by engaging in sexual behavior that is meaningful and nourishing to them rather than judge and impose subjective beliefs of sexuality and sex.
Garcia, F. D. & Thibaut, F. (2010). Sexual addiction. The American Journal of Drug and Alcohol Abuse, 36, 254-260. doi:10.3109/00952990.1010.503823
Klein, M. (2003) Sex addiction: A dangerous clinical concept. SIECUS Report, Vol. 31, No. 5, 77-80.
Ley, D. J. (2012). The myth of sex addiction [Kindle Edition]. Plymouth, United Kingdom: Rowman and Littlefield Publishers.